Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | OT020764 | PA |
Y | 208600000X | Surgeon | OT020764 | PA |
NPI | 1003481334 |
---|---|
Provider Name | Bradley Stephen Winegardner |
First Address | Johnstown, PA 15905-4305 |
Second Address | Johnstown, PA 15905-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2021 |
Last Update Date | 20/05/2021 |